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Initial management of seizure in adults

Smith, Phil E. M. 2021. Initial management of seizure in adults. New England Journal of Medicine 385 , pp. 251-263. 10.1056/NEJMcp2024526

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Abstract

• The clinical diagnosis of an epileptic seizure requires a detailed history taking and, ideally, an eyewitness account of the seizure. • Evaluation with 12-lead electrocardiography is essential in a patient who has had a first seizure or an unexplained blackout spell. • In children and teenagers, interictal electroencephalography, ideally within 24 hours after a first seizure, is particularly important. • All patients who have had a suspected focal-onset seizure should undergo detailed magnetic resonance imaging of the head. • Patients who have had an epileptic seizure should be informed about factors that may provoke seizures (e.g., sleep deprivation and alcohol use), the risk of a seizure occurring while driving or engaging in solitary activities, and the risks of harm from further seizures. • Data from long-term pragmatic trials suggest that the first-line medication for patients with focal-onset seizures is either lamotrigine or levetiracetam, although other reasonable options are available; for patients with generalized-onset seizures, the first choice is sodium valproate, except for women of childbearing potential, in whom the first-line medication is usually levetiracetam.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Publisher: Massachusetts Medical Society
ISSN: 0028-4793
Date of First Compliant Deposit: 21 July 2021
Date of Acceptance: 7 June 2021
Last Modified: 15 Dec 2021 02:30
URI: https://orca.cardiff.ac.uk/id/eprint/142614

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